★54th Atopic Dermatitis Lecture on Zoom★
The content of this seminar is for junior high school students and up, however, it is useful for all ages, Of course, you don't have to be a patient or a family member of a patient to learn about this seminar.
https://atopic.info/blog/event/lecture/2024/03/5022
However, please understand that the content does not recommend the use of steroids or topical protopics for atopic dermatitis. (This is not a discussion forum, so please refrain from attending if you have a different policy.)
■Date and Time
Sunday, April 28, 2024, 13:30~ (about 3 hours)
■Contents
Lectures by 3 doctors, patient experiences, Q&A session
■Place
ZOOM ( your own computer, etc.)
■Admission
Free of charge
■Capacity
100 people
★This is the original "Topical Steroid Withdrawal" from the UK.★
★Information for TSW/NMT sufferers★
February 11th, 2024 | Posted by Kenji Sato
Information for foreign patients who wish to receive TSW & NMT treatment at Hannan Chuo Hospital
Please check the following in Atopic's website.
↓↓↓↓↓
INFORMATION FOR TSW/NMT SUFFERERS
TITLES OF CONTENT
https://atopic.info/to-tsw-nmt-sufferers
The Japanese government has ordered that patients without Japanese medical insurance not be charged more for medical care than they would be charged under the Japanese medical system. Hannan Chuo Hospital follows those instructions. The reason why patients with Japanese medical insurance pay less is because 70% of the cost is paid by medical insurance. Payment is even easier with the high-cost medical care system.
I appreciate the hospital administration and atopic staff for their great help in announcing this notice to the public.
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★The 53rd Atopic Dermatitis Lecture 11/25★
November 26th, 2023 | Posted by Kenji Sato
To all who attended the 53rd Atopic Dermatitis Lecture.
Thank you for attending in large numbers at this busy time of the year. I hope you were able to learn about the various problems with the standard treatment of atopic dermatitis. We hope that you will think carefully about the content of the lecture and connect it to better atopic dermatitis treatment.
I was a little worried that the audience would not attend our first face-to-face lecture in a while, but I am very happy to see many of you filled the hall. You asked many questions, and I, as a speaker, was very energetic.
The reception after the lecture was also very lively and well attended. We hope that you will continue to attend our lectures, spread your knowledge, and make many friends.
Thanks to the volunteers who took care of all the details of the lecture, the event went very smoothly. Many thanks for your hard work.
Kenji Sato
★The 53rd Atopic Dermatitis Lecture Meeting in Yokohama★
🔸Date/Time
Saturday, November 25, 2023
13:00-17:30 (Doors open at 12:45)
Part 1 (for infant patients): 13:00-14:50
Part 2 (adult patients): 15:00-17:30
🔸Place/Yokohama City Sports Medicine and Science Center Large Training Room
🔸Participation fee: Free
🔸Availability/100 people for each part
🔸Access/15 min. walk from Shin-Yokohama Sta. on each line
All lectures and Q&A sessions will be conducted in Japanese.
Check the website.→https://atopic.info/
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★The 52nd Atopic Lecture Meeting on Zoom★
Sep. 23 (Sun.) , 13:30 - 16:30 (JST).
Dear all
The flyer for the 52nd Atopic Lecture, Sept. 23, is ready. Please join us in this meeting by all means.
All lectures and Q&A sessions will be conducted in Japanese.
Check the website.→https://atopic.info/
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Differentiation between Atopic Dermatitis (AD) and TSW
May 4th, 2023 | Posted by Kenji Sato
I received the following email from ITSAN. I would like to share it with you because it is very important.
Calling TSW Warriors in the DC, Maryland and Virginia area!
The National Institutes of Health (NIH), is conducting a pilot study of Topical Steroid Withdrawal Syndrome with the aim of examining how TSW Syndrome differentiates from eczema, and the adverse impact topical steroids have on some people. This study will perform in-depth analysis of samples from 5 -7 individuals including; skin biopsies, blood and DNA.
★Dr. Kenji Sato comments:
The National Institutes of Health (NIH) in the US has finally started to consider how to differentiate atopic dermatitis from steroid withdrawal symptoms.
The differentiation in my view:
〇Weakening of steroid efficacy (need for stronger drugs or more frequent topical application)
〇Expansion of the rash after discontinuation of topical application.
〇Widespread of the rash beyond the preferred site of atopic dermatitis
〇Obscuration of lichenification of the skin, especially in the elbow and knee sockets
〇The rash tends to be more moist.
〇In the case of localized lichenification, the marginal ridges are gentle.
Any additional comments you may have would be appreciated.
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★Atopic's 51st Lecture (April 30) was featured in the Chunichi Shimbun Posted by Kenji Sato
Atopic's 51st Lecture on Atopic Dermatitis (in Nagoya) was featured in the Chunichi Shimbun.
The article modestly describes our arguments. Just read it.
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★230201 Non steroid asthma medication★
1. β２stimulators
salbutamol sulfate
Venetlin 4mgx3 times/day
Sultanol
procaterol hydrochloride
Meptin 50μgTx1-2times/day
Air, kid air, swinghaler
tulobuterol
Hokunalin
Dry syrup, tape once a day 2mg
clenbuterol hydrochloride
Spiropent 20μgTｘ2 times/day
salmeterol xinafoate
Serevent 50μg 2 times/day
２．theophylline
Theodur 100mg x 2times
Theolong 200mg x once
aminophylline
Neophyllin 100mg x 3 times/day
intravenous drip (IV)
proxyphylline
Monophyllin 100mg x 2 times/day
３．anticholinergics
tiotropium bromide hydrate
Spiriva 2 inhalations once a day inhale
glycopyrronium bromide
Seebri (inhalation capsule)
4． leukotriene receptor antagonist
pranlukast hydrate
Onon 112.5mg 2 caps x 2 times/day
Pranlukast
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About Periostin and drug candidate CP4715 (news flash) January 10, 2023 SAGA TV NEWS
★Here is Dr. Kenji Sato's view on this presentation.
Presentation by Department of Molecular Bioscience, Faculty of Medicine, Saga University. The research group in this course previously published Chronicity of Atopic Dermatitis by Periostin on June 1, 2012 (saga-u.ac.jp), showing the below.
"This research group has shown that the protein periostin is responsible for the chronicity of atopic dermatitis. In patients with atopic dermatitis, periostin is produced in large amounts and deposited in skin tissues by stimulation of inflammatory mediators called interleukin 4 and 13. The deposited periostin stimulates epidermal cells to produce other inflammatory mediators, further continuing the inflammation. Thus, once periostin is produced and deposited in the tissues, the cycle of continuous inflammation in the body rotates regardless of external stimuli. This leads to the chronicity of atopic dermatitis."
This means that once the symptoms start, they do not stop and get worse. However, atopic dermatitis in humans heals spontaneously. Moreover, since topical steroids have been shown to be the reason for the chronicity of atopic dermatitis through TSW, this seems to be a far different idea from what is actually happening in humans.
In this announcement, "The researchers have identified the protein periostin as one of the causes of the intense itching associated with atopic dermatitis." The professor also reportedly said, "The causes are diverse, so it is not a panacea, but we would like to advance basic research to confirm its safety and aim for its approval as a drug."
Anything that produces inflammatory cytokines, such as periostin, could cause itching, so it would be an itch inducer. However, CP4715 is being developed as an antithrombotic agent, and if administered, it would be highly unlikely that it would be a viable treatment for atopy, as a little scratching would result in endless bleeding.
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Withdrawal symptoms of topical steroids also a problem in Singapore.
Following the UK and Canada, Singapore has begun to recognize "topical steroid withdrawal symptoms" as a side effect of topical steroids by a government agency.
Just check the following URL.
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The general trend of TSW hesitancy 12.4.2022
Posted by Kenji Sato
Recent advertisements by dermatology-related pharmaceutical companies are line up with biologics for atopic dermatitis.
Let's take a look at the history. Topical steroid treatment began in 1954. It dramatically reduced inflammation. In an attempt to further accelerate the effect, more potent formulations were developed one after another. It was hoped that this would solve the problem of atopic dermatitis. However, the disease changed, and the number of cases that could not be cured even in adulthood increased.
Based on the idea that atopic dermatitis is caused by allergies, topical immunosuppressants (Protopic) were developed, and the indication for oral immunosuppressants (Neoral) was expanded to include atopic dermatitis. However, this did not prevent the increase in the number of patients, and the number of patients further increased: according to a survey conducted by the Japanese Dermatological Association in 2007-2008, the number of patients increased from adolescence to adulthood. Dermatologists must first consider what is causing this increase in adult-onset atopic dermatitis patients. Then, according to their conclusions, we should consider what should be done to reduce the increase.
Regarding the cause of the increase in the number of patients, The Japanese Dermatological Association does not consider the view of the cause of side effects of therapeutic drugs (the idea that steroids are the cause of the deterioration), which patients have complained about, and avoids hearing this idea at all. On the contrary, it recommends that topical application of steroids be increased by following the FTU (finger tip unit) for the area to be topically applied and by promoting the Proactive treatment method.
We have proven that adult-onset atopic dermatitis disappears when topical steroids, immunosuppressants, and moisturizers are discontinued. They refuse to see as objective fact that patients with adult-onset atopic dermatitis get better with TSW treatment and NMT, avoiding and obstructing the spread of the fact. Under these circumstances, biologics were developed and covered by insurance for atopic dermatitis.
The number of patients is expected to continue to increase under the treatment policy of The Japanese Dermatological Association, and pharmaceutical companies, believing that they can sell this new-concept treatment policy as a high-priced product, are pushing hard to develop it. The leaders of the association are taking advantage of this trend by the pharmaceutical companies and are partaking in a great deal of publicity, thinking that they can solve the steroid-related problems. Possibly, it makes sense to use a new drug to stop steroids. However, the use of many biologics is mandated in combination with steroids and moisturizers. Although only recently covered by insurance, it is already beginning to become clear that it does not go well (solving the increasing number of patients with atopic dermatitis). The high cost of the treatment makes it impossible to continue it, and the effects are not long-lasting. As for topical agents, they cannot solve the problem of moisturizer dependence and are not very effective in the first place. Treatments without stopping the topical steroids application and moisturizers will run into the problem of steroid dependence and moisturizer dependence and will not work well. And, unfortunately, serious side effects are expected to occur in the future.
The Dermatological community around the world should focus on TSW and NMT without avoiding them, and restructure the treatment of atopic dermatitis in a way that uses as few steroids as possible.
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★Atopic Lecture 50th Anniversary Meeting★
Sep. 18 (Sun.) , 10:00 - 15:30 (JST).
Online meeting on ZOOM
Free of charge / Quite a lot of people are available. Please join us!
Check the website.→https://atopic.info/blog/event/lecture/2022/08/3358
All lectures and Q&A sessions will be conducted in Japanese.
Speakers:
【Medical doctor】
Dr. Shigeki Fujisawa
Dr. Satoko Minaguchi
Dr. Mitsuko Sato
Dr. Kenji Sato
【TSW & NMT Experiencer】
Ms. Madoka Endo
Ms. Tokuko Kameda
Mr. Kazuaki Abe
(Q&A session)
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Aug. 10
Today, another patient was seen who was misdiagnosed with steroid-dependent dermatosis as "just a rash". He complained that he had used disinfectant spray, which caused red oozing skin. If his complaint was correct, the border of the rash should have been indistinct. However, the border of the erythema was clear and edematous erythema. When I asked him about it, he told me that he had been applying steroids to the area until now. According to his medication book, ANTEBATE Ointment and other cream had been prescribed for at least four months. This is evidence that steroid dependence is occurring in people, not only atopic dermatitis. If you feel that the effects of applying steroids are fading, you should consider that steroid dependence has begun. Be careful when stopping or reducing topical application because it is ineffective, as the symptoms may resemble a rash. It is important to ask about the term of topical steroid use.
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Dear all
The current forum has been closed and a new "Forum" has been created on the Atopic home page. Click on "アトピー患者交流フォーラム (Forum)" at the far right of the home page, then click on "新規トピックを投稿する (Post New Topic)". Please enter your "name" (public, real name, nickname, whatever you want), email address (not open), and "title" and you can post what you want to say, what you want to ask, and anything else inside the frame below to exchange opinions. Let's meet on the new Forum!!
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Alternatives to this site (https://8617.teacup.com/atopy/bbs)←closing soon
Hi, everyone.
This site will be closed at the end of July. Many of you have requested a kind of replacement, so I have asked the members of Atopic to create one for you. Please click on "Forum" on the right side of the Atopic homepage (https://atopic.info/). You will be able to communicate with us here as you have in the past. We hope to see you all again at the new forum.
I would appreciate it if you could spread the word to let more people know about this site. Thank you in advance.
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Intense Withdrawal Symptoms of TS
People with severe withdrawal symptoms from TS and NMT need more time to get better. I will tell these people to "hang in there," more often and the term I say this phrase would be longer. I think it is better to say it gently, but I tend to speak (express) it strongly like a Jock. I think I need to change this, but it is surprisingly difficult.
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Vietnamese babies
posted by Kenji Sato
I don’t know why but many baby-patients come to see me recently. Of cause they are for treatment of eczema. Technically speaking, it's for Steroid-dependent symptoms, rather than just eczema. I would like you to spread through your network of Vietnamese people living in Japan that steroids should not be used for eczema in babies.
It might be the same reason but I'm also getting a sudden increase in friend requests on Facebook. I can't see if they want to gain knowledge about TSW or not. I have no idea why.
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Jul. 17 (Sun.) Meeting up on Zoom "Tomarigi" at 1:30 pm (JST).
(Dr. Sato) It has been a while, but we will have Tomariki online. We will be talking about "Parent-Child Relationship", "Skin Rash Control", "Antiallergic Drug Issues", and "TSW and Menses Issues". We cover problems that commonly occur in childhood atopic dermatitis. The lecture will be easy to understand showing case examples.
All lectures and Q&A sessions will be conducted in Japanese.
Check the website. → https://atopic.info/blog/event/2022/06/3219
This time, participants are mainly parents with children under high school age. Of course, children are also welcome.
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Jun. 27
Atopic dermatitis in some children is difficult to treat. I will give examples of aggravating factors and would like you to draw out some generalizations from them.
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Jun. 16
(Dr. Sato) This is a report on TSW in the UK. Please check the below. The Japanese translation is easy to understand. I hope it will spread around the world, especially in Japan.
It's not good to depend on others. TSW are beginning to be recognized in the UK, and this is because of the hard work of British TSW patients. I believe we need to work hard in Japan, where TSW & NMT originated.
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Mar. 27 (Sun.) Meeting up on Zoom "Tomarigi"
(Dr. Sato) We will have a "Tomarigi" meeting online this Sunday, March 27 at 1:30 pm (JST). The theme will be "2021 Atopic Dermatitis Guidelines and the Issue of TSW Movement" The new guidelines came out at the end of 2021. There are a lot of new drugs coming out and I think we need to have enough knowledge about them. This may sound a bit complicated, but I'm sure it is important, and I would appreciate it if you could listen to it carefully.
All lectures and Q&A sessions will be conducted in Japanese.
Check the website. → https://atopic.info/blog/event/2022/03/3159
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Cartoon, Introduction to TSW (Japanese comic book)
The book "Cartoon, Introduction to Steroid Withdrawal, Steroid-withdrawal Diary for Everybody" (written by Yoshimi Numajiri) will be released on January 27, 2022. You can learn about TSW while having fun. I recommend that you read it. For the details, please visit the following URL: https://tsugeshobo.com/modules/books/index.php?lid=143
TSW experience and stories -This book is a more comprehensive summary of TSW.
It will be a must-read book for patients with atopic dermatitis. Supervised by Dr. Kenji Sato.
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Dealing with asthma during TSW.
posted by Kenji Sato
The current asthma treatment recommends the use of leukotriene receptor antagonists and slow release theophylline for patients who cannot use steroids, and the use of short-acting β-agonists during attacks. If asthma symptoms occur, a general physician or a respiratory specialist doctor should be consulted. In that case, inhaled corticosteroid(ICS) is recommended first. People who are undergoing TSW for atopic dermatitis should be better to say, "I think that if I inhale steroids, my asthma will get better and my skin rash will get better. However, when the asthma gets better and the steroids are stopped, the skin may get much worse. For this reason, I would like to have asthma treatment without steroids as much as possible. I think it is better to express this wish to your doctor. As a doctor with non-steroids treatment, I would like to see more physicians who are willing to fulfill and understand this request.
I'm not an asthma expert, but the basics of asthma treatment are
(1) Suppress airway inflammation with anti-inflammatory drugs
(2) To improve symptoms with bronchodilators.
For (1), steroids are used. For (2), there are a variety of drugs described below.
Bronchodilators are:
1) β2 stimulants, such as Meptin air and Sultanol for short-acting β-agonists, and Serevent, Oxis®, Onbrez for long-acting β-agonists.
2) Anticholinergic agent: Atrovent for short-acting type, Spiriva, Seebri, and Encruse for long-acting type.
3) Xanthine derivatives (aminophylline) include theophylline.
4) Leukotriene receptor antagonists include Onon.
Please note that there are many generic drugs these days, so there are many different names. When you are in severe asthma condition (like danger of losing your life), the use of steroids would be necessary.
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Criticism of "Criticism for World Gyoten News (Japanese TV program)" -Detailed Edition-
by Kenji Sato
Nippon Television Network Corporation broadcasted "The! World Gyoten News: Severe Skin Problems Recovered by an Unexpected Method" on September 7, 2021. If you watch this news without any prejudice, you all may think, "Oh, yes, it is possible to overcome eczema even after stopping topical steroids. That’s really good." However, the Japanese Dermatological Association and other organizations issued a statement saying, "We have made a strong protest, saying it is unacceptable that such a program is broadcasted and causes confusion in the medical field. I cannot quite understand why they feel indignant about reporting that skin rash was getting better, so I examined the legitimacy of their protest.
[Regarding the first paragraph]
In the TV program, it said "Steroids are originally produced by the body, but the body no longer produces them due to overuse of steroid ointment." and "The only way to get the body to make steroids again is to stop applying steroids." In these regards, the academic community has said that this content contains some parts no clear scientific basis for this. However, the Guidelines for the Treatment of Atopic Dermatitis (Journal of the Japanese Dermatological Association 2018; 128: 2431-2502; hereafter referred to as the 2018 Guidelines), issued in 2018, states on page 2458 that "strong-class topical steroids have been reported to cause suppression of adrenal function in some cases."
In other words, it says that overuse of steroids can make it difficult for steroids to be produced, and it also means that steroids must be reduced or stopped in order that they can be made. Actually I think the probability of adrenal insufficiency is low when it is applied externally to the face only like being shown on TV. But that doesn't mean the news is totally wrong. I’m sure this expression, which seems problematic for the entire news story because of this slight inaccuracy, is inappropriate behavior as a scientist to ignore the important fact that steroids have been stopped and the rash has improved.
The guideline (2009) states that for simple application of Strong Class (Rinderon®-V), 20 g topical application is the daily topical dose that could cause adrenal function suppression. Incidentally, for FTU (Finger Tip Unit) topical therapy, which the guideline (2018) lists as a reference, the topical dosage for people with erythroderma (redness all over the body) is 20.25 grams, which means that they are recommending to treat treatment in the danger zone of causing adrenal function suppression. I believe this should be mentioned in the guidelines as a precaution. Recently, I have really felt that very-strong-class topical steroids, which are one step stronger than the strong class, not strong-class one, are being used for patients more frequently. Furthermore, I am concerned about the risk of adrenal function suppression, which could be beginning to occur in many people.
[Regarding the second paragraph]
They criticize this TV program for:
1. causing fear and anxiety among all steroid users by describing steroids in general without distinguishing between the different types of steroids and how they are used.
2. using the word "therapy" to create expectations that the disease can be cured by non-use of steroids.
3. causing anxiety and disturbance to doctors and patients who are aware of the dangers of steroids and are treating atopic dermatitis according to the guidelines.
4. the high possibility of health problems influencing by this TV program.
Regarding #1, it is clear that the drugs used actually were steroids in general, although the each product name was not showed, and that the skin rash worsened with their use and improved after stopping the use. Therefore, the content of this program is saying to patients and doctors under steroid treatment that they have to be cautious about using steroids, and it's also showing that there is hope that such skin rashes can improve with proper treatment.
Regarding #2, if the steroid-free treatment is ineffective, it will not get better even if we use the word "treatment". However, in reality, it did get better. The reason for this is not just because of the name "treatment," but we should think it has improved because it actually works. So we should call it a useful broadcast that showed that not using steroids can raise expectations that diseases can be cured.
Regarding #3, the patient on this program has rosacea-like dermatitis, not atopic dermatitis, and the content has nothing to do with doctors treating atopic dermatitis and patients. In spite of this, the academic society described on purpose or not the atopic dermatitis treatment guidelines. This means Japanese Dermatological Association is afraid that the term "TSW" has been a significant impact on the treatment of atopic dermatitis, I think.
Regarding #4, the program only showed that when steroids were stopped on skin that had been aggravated by using steroids, the skin temporarily got worse but then got better. In the case of rosacea-like dermatitis, what the Japanese Dermatological Association needs to do is not to worry about the potential health risks, but to figure out how to discontinue steroids without causing the severe symptoms possible.
[Regarding the third paragraph]
In order to prevent the rampant use of inappropriate treatment, say "TSW," the Japanese Dermatological Association has formulated "Guidelines for the Treatment of Atopic Dermatitis" as a standard treatment and has been working to spread. But the Japanese Dermatological Association and other organizations have said that the mass media's reoccurrence of misunderstandings and false reports about topical steroids again is causing confusion in medicine and cannot be overlooked, so they are protesting.
Oh, they're switching the subject to atopic dermatitis here, too. Let me repeat, the TV program is about rosacea-like dermatitis that developed after topical steroid use and got better after TSW. It is clear from a bunch of social media that there are people with atopic dermatitis who have used steroid for decades are no longer suffering from skin rashes and are living a comfortable life after TSW. There are reports of people who have gotten better with TSW, even if there are only a few references. Why do they ignore all of this and deny all aspects of TSW? It is really hard to understand their point of view.
From Dr. Sato's point of view on the content of the protest.
1. They emphasize only some parts of inaccuracies in this content and tries to make it seem as if the entire content is unscientific.
2. Without clarifying that the patient's disease was rosacea-like dermatitis, they refer as if it was a case of atopic dermatitis patients being symptom of TSW and are denying all as usual way of "TSW" as general dermatologists has tended to accept. By doing this, they are hiding the fact that the cause of rosacea-like dermatitis is from applying topical steroids and that the treatment for rosacea-like dermatitis is to stop topical steroid use (TSW).
3. In this TV show, the media reported the fact that this case was rosacea-like dermatitis, and that the skin rash improved greatly with the discontinuation of steroids (TSW), which is the standard treatment for this disease. For the Japanese Dermatological Association, it seems that it should never happen that a skin rash can get better with TSW treatment. Scientists must base their evaluations on facts. If they don't accept the fact that skin rash got better with TSW, then they behavior is not the attitude of scientists.
After successful treatment with so-called “TSW treatment”, many dermatology patients and doctors are aware of the effectiveness of TSW in the treatment of atopic dermatitis. The British Association of Dermatology and the British Eczema Society in their joint statement of 2021 recognized steroid withdrawal as one of the treatments for refractory atopic dermatitis during steroid use. On the Internet, we can find many atopic dermatitis patients around the world are getting better with TSW and NMT. As this situation proceeds, I believe that TSW treatment methods must be made public and approved.
For rosacea-like dermatitis, the guidelines should at least indicate how to treat it after steroid withdrawal, but they only state "refer to a dermatologist". If the treatment methods were described, we would be able to treat patients with rosacea-like dermatitis with confidence.
Since rosacea-like dermatitis is the case on face of steroid-dependent dermatosis, it can also be beneficial for patients with atopic dermatitis associated with steroid-dependent dermatosis. Furthermore, parents who do not want their children to use steroids will not have to worry about their children being taken away by child guidance centers because they are mistakenly thought to abuse their children, and they will be able to safely receive non-steroidal treatment at a nearby medical institution. If this were to happen, we would no longer have to see exhausted mothers due to no facilities to consult and dehydrated babies.
【Bibliography of Causes and Treatments of Rosacea-like Dermatitis】
Here are some dermatology textbooks on the causes and treatment of rosacea-like dermatitis.
#TEXT Dermatology, edited by Masaaki Ito, Hideoki Ogawa, and Masato Niimura, Nanzan-do, Tokyo, 1998, p240.
Rosacea-like dermatitis.
Side effects of long-term continuous use of topical steroids---refractory.
#Dermatology, Edited by Fujio Otsuka, 9th Edition, Kinpodo, Kyoto, Japan, 2011, p704
Rosacea -like dermatitis.
A type of local side effect caused by topical steroids. ---When topical steroids are discontinued for treatment, the rebound is severe, but it must be overcome.
#Dermatology Resident's Manual, edited by Koji Sugawara and Daisuke Tsuruta, Igaku Shoin, Tokyo, Japan, 2018, p285.
Rosacea-like dermatitis:.
Occurs with long-term use of topical steroids on the face. ---Discontinuation of topical steroids is the basic treatment, but it should be done with caution and attention to the rebound phenomenon.
Thus, the cause of rosacea-like dermatitis is topical steroids, and the treatment for this is discontinuation of steroids.
The 2018 Guidelines (page 2459) include the following description of rosacea-like dermatitis
Rosacea-like dermatitis is a side effect of topical steroid medication that occurs mainly in adults with long-term use of topical steroids on the face, and includes erythema, telangiectasia, follicular papule, and pustule. If these symptoms are observed, the patient should be referred to a dermatologist as soon as possible."
(Author's note: There is, however, no mention of what kind of treatment a dermatologist should provide.)
The letter of protest from the Japanese Dermatological Assoc. and other organizations can be seen below.
https://www.dermatol.or.jp/modules/publicnews/index.php?content_id=12
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12/5 (Sun.) Atopic Lecture on Zoom. All lectures and Q&A sessions will be conducted in Japanese.
Dear all
The 49th Lecture on Atopic Dermatitis by Atopic will be held on Zoom on Sunday, December 5, from 1:30 pm. Please join us.
https://ssl.form-mailer.jp/fms/833e854b724742
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The Japanese TV program called The World's Gyoten News On September 7 at 9:00 p.m., featured a patient who got through TSW.
【The following: Comments and Views from Dr. Kenji Sato on criticism for this program by the Japanese Dermatological Association and others.】
The written protest from the Japanese Dermatological Association criticizes the program for misleading the public with false scientific explanations, but it never mentions that the disease got worse when the steroids were stopped, and that it took a long time but the skin healed very well. This patient had originally rosacea-like dermatitis, and the treatment for this is the discontinuation of steroids both in the guidelines and in standard dermatology textbooks. No mention was made of this, why?
In the episode broadcasted on September 7, it was explained that the severe symptoms were caused by the decrease in steroid production by the adrenal glands due to topical steroid use and the loss of steroids due to the discontinuation of steroids, but this is a phenomenon that occurs when large amounts of steroids are applied to the entire body. In fact, this is also mentioned in the guidelines. It is a fact that it is unlikely to occur with a certain amount of topical application (e.g.: to the face only). It is certainly a problem to have explained the phenomenon incorrectly in the broadcast, but I think it is a bigger problem to ignore the fact that the condition worsened when the topical application was stopped and that it would have improved over time.
The mission of science is to explain the facts, and I believe that ignoring the facts is a deviation from the basics of science. I think the each association and others who have issued criticisms have an obligation to think carefully about this point.
In 2017, it was proven that steroids are produced in the skin, experimented in rats though. The existence of all the enzymes that make steroid hormones in human skin has also been proven. Finding out this fact, it is quite normal to think that if we apply artificial steroids to the skin, the production of steroids in the skin will be suppressed by a feedback mechanism, and if we stop applying steroids, the production of steroids will not be sufficient and inflammation will occur due to steroid deficiency in the skin. If this explanation had been given, the Japanese Dermatological Association would not have been able to criticize it.
In January 2021, in the UK, the National Eczema Society and the British Association of Dermatologists announced that withdrawal from steroids is one treatment for cases of atopic dermatitis that are difficult to cure. I think that Japanese association is rather far behind.
